Exploring the Multivariate Relationships between …file.scirp.org/pdf/Health_2017011115111699.pdfsupport, religiosity, and spirituality during the period of adolescence in any set-ting

Health, 2017, 9, 38-56 http://www.scirp.org/journal/health

ISSN Online: 1949-5005 ISSN Print: 1949-4998

DOI: 10.4236/health.2017.91004 January 11, 2017

Exploring the Multivariate Relationships between Adolescent Depression and Social Support, Religiosity, and Spirituality in a Faith-Based High School

Angela U. Ekwonye1*, Terrence F. Cahill2, Deborah De Luca2, Lee Cabell2

1Department of Public Health, Franklin Pierce University, Rindge, NH, USA 2School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA

Abstract Depression is one of the most common psychological disorders that affect adolescents. In this study, we investigated how depression in adolescents re-lates to social support, religiosity, and spirituality in multivariate analyses. We also investigated whether age, gender and ethnicity are predictors of depres-sion among adolescents in a faith-based high school. We measured social support using the Child and Adolescent Social Support Scale (CASSS), reli-giosity with the Duke University Religion Index (DUREL); spirituality with the Spiritual Well-Being Scale (SWBS); and depression with the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Results of the bivariate analyses showed a significant negative association between de-pression and social support, religiosity, and spirituality (p < 0.05). In the mul-tiple regression analyses, religiosity was positively related to adolescent de-pression (r = 0.121, p < 0.05), while spirituality (r = −0.548, p = 0.00) was ne-gatively related to depression in adolescents. The study found significant gender differences only in religiosity, while significant ethnic differences were only found in social support. Implications to education, practice, research and future directions of study are discussed. Keywords Social Support, Religiosity, Spirituality, Depression, Adolescents, Faith-Based

1. Introduction

Depression is one of the most common psychological disorders that affect ado-lescents [1] and remains a huge public health problem. With significant beha-

How to cite this paper: Ekwonye, A.U., Ca- hill, T.F., De Luca, D. and Cabell, L. (2017) Exploring the Multivariate Relationships be- tween Adolescent Depression and Social Sup- port, Religiosity, and Spirituality in a Faith- Based High School. Health, 9, 38-56. http://dx.doi.org/10.4236/health.2017.91004 Received: November 8, 2016 Accepted: January 8, 2017 Published: January 11, 2017 Copyright © 2017 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/

Open Access

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vioral, cognitive, and emotional impairment that accompany depression in ado-lescents [2] [3] [4], the problem cannot be ignored. Studies show that adolescent depression is prevalent in the United States [5] [6] and worldwide [7] [8]. Cur-rently in the United States, about 11.4% of adolescents, an estimated 2.8 million adolescents had a major depressive episode during the past year [9]. About 8.2% of the adolescents who had a major depressive episode had severe difficulty com- pleting school work, chores at home, and forming close relationships with friends and family [9]. Previous studies show that the occurrence of depression during adolescence not only increases the risk of future episodes in later life [5], but it is also associated with academic difficulties [6] [10], school dropout [11], antisocial behaviors [12] [13] [14], health risk behaviors such as smoking, violence, drug use, unprotected sex, drunk driving and driving without seatbelt [15] [16] [17], and suicide risk [18]. The risk of developing depression during adolescence in-creases with lack of self-esteem, stress, and social isolation [19] [20] [21]. With evidence of substantial health risks associated with depression, there is a need to explore how adolescent depression relates to combinations of factors that may protect the individual from depression.

A review of over 40 correlational articles found evidence that actual reception or perception of support is beneficial to individual’s psychological well-being [22]. Previous studies show that perception or reception of support from family, friends, and teachers, prayer and participation in religious events, and having the calmness and harmony of mind that spirituality offers counter adolescent de-pression [6] [23] [24]. Therefore, protective measures such as social support, re-ligiosity, and spirituality may be very important psychologically resources that adolescents can draw upon for better mental health. If so, these measures should also help adolescents deal with the emotional instability which characterizes ado-lescence.

Social support refers to an individual’s perception or reception of emotional, informational, appraisal, and tangible support from people in their social net-work [25]. The relationship between adolescent depression and social support has been extensively investigated in empirical studies. Higher levels of friend support, family support, and overall emotional support have been consistently associated with lower odds of adolescent depression [21] [26] [27] [28]. Social relationships may promote well-being by enhancing an individual’s feelings of predictability and stability, maintaining positive emotional states, promoting an individual’s sense of purpose, belonging, and security and enhancing self-esteem through social recognition of self-worth [29]. Religiosity is an important psy-chological asset that adolescents can draw on for better mental health. Religiosity refers to an individual’s religious affiliation and beliefs and the degree to which he/she prays and attends religious services [30]. Religious attendance, self- ranked religiousness and positive religious experience have been associated with lower depressive symptoms in adolescents [23] [31] [32]. However, intrinsic re-ligiosity, private religious practices such as private prayer and reading spiritual books were not associated with depression in adolescents [26] [31] [33]. Spiri-

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tuality is another significant resource adolescents can turn to during periods of psychological distress. Spirituality refers to the sense of well-being that arises from values such as compassion, love, forgiveness, and one’s relationship with God, people, nature, and the meaning found in these relationships and life expe-riences [34] [35]. Studies have repeatedly demonstrated a negative association between depression and spirituality [36] [37]. The negative correlation found between spirituality and depression may be due to greater spiritual well-being which not only facilitates more positive and healthy personal and social beha-viors, but provides a unifying framework that helps individuals cope with unex-pected and difficult life situations [37]. Increased spirituality was correlated with lower levels of depression, whereas higher levels of religious importance were correlated with more depression in adolescents [24].

So far most studies have focused on the bivariate relationship between adoles-cent depression and social support, religiosity, and spirituality. However, no study has yet explored multivariate relationships between depression and social support, religiosity, and spirituality during the period of adolescence in any set-ting and specifically in faith-based high schools. Since the teaching of religion is not allowed in public schools in the United States, faith-based schools therefore provide logical setting to explore how depression relates to the combinations of social support, religiosity, and spirituality during adolescence. Therefore, the primary objective of this study was to investigate how depression in adolescents relates to social support, religiosity, and spirituality in multivariate analyses and whether age, gender and ethnicity are predictors of depression among adoles-cents in a faith-based high school.

2. Methods 2.1. Participants

Participants were recruited upon study approval by Seton Hall University Insti-tutional Review Board (IRB). The study was permitted by the Catholic Arch-diocesan School Superintendent and the School Principal. A numerically coded eligibility form, parent solicitation letter, and parent/guardian consent form were mailed to parents/guardians of all students (N = 1569). A total of 512 packages were returned through postal mail and hand-delivery by students. Each student who received parental approval was given a package containing a nu-merically coded eligibility form, solicitation letter, and assent form through their homeroom teachers. Students were asked to drop off the completed package in a labeled box in the main office of the school within 24 hours. The list of students who agreed to participate in the study was checked against the list of consenting parent/guardian to ensure that each child’s parent/guardian also gave consent. Students who assented were included as study participants. The secretary mailed copies of the signed documents to parent/guardian and also gave copies of the signed assent form to individual students before the study began. A convenience sample of 394 students from a population of 1569 in the faith-based high school participated in the study by completing the surveys that measure levels of de-

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pressive symptoms, social support, religiosity, and spirituality.

2.2. Inclusion/Exclusion Criteria

The subjects included in this study were adolescents, ages 14 - 17 years old who had parental approval and who also assented to participate in the study. Exclu-sion criteria for the study required that individuals cannot be taking any medica-tion with the exception of seasonal allergies, asthma, acne and/or antibiotics within the last thirty days, do not have prior history of diagnosis of a major de-pressive episode, and had not received any form of talk therapy from any of the following professionals: psychologist, counselor, psychiatrist, or psychoanalyst. The criteria for selecting adolescents’ ages 14 - 17 years old was based on the findings that over 10% of adolescents aged 12 to 17 experience at least one major depressive episode during this period of their life [9]. The inclusion of non-de- pressed adolescents (adolescents not taking any antidepressant medication) was based on the exploratory and non-diagnostic nature of this study.

2.3. Depressive Symptoms Measure

The Center for Epidemiological Studies Depression Scale for Children (CES-DC) was used to measure the level of depressive symptoms in the participants. This 20-item self-administered scale measures the major components of depressive symptomatology including sadness or irritability, loss of interest, feelings of guilt and worthlessness, psychomotor retardation, loss of appetite, and sleep distur-bance and does not include items that assess suicidal ideation to lessen any ad-verse outcome with children and adolescent samples. For each item, respondents were asked to indicate how frequently they experienced the symptom within the past week. Responses include: 0 = Not at all, 1 = A little, 2 = Some, 3 = A lot. Sample item includes: “I was bothered by things that usually don’t bother me.” The scores are summed up to provide total scores in the range from 0 to 60, with higher scores indicating higher frequency of depressive symptomatology. A cu-toff score of 15 is suggestive of significant depression in adolescents [38]. The CES-DC is a valid measure of depressive symptoms in children aged 12 - 18 years old and its established internal consistency reliability ranges from 0.84 - 0.88 [38] [39].

2.4. Social Support Measure

Social Support was measured as an individual’s perception or reception of sup-port or help from parent(s), teachers, classmates, and close friends. This variable was measured using the Child and Adolescent Social Support Scale (CASSS) which is a 48-item multidimensional self-administered scale. Study participants were asked to respond to statements such as, “My parent(s) give me good ad-vice,” “My teacher(s) understands me,” “My classmates ask me to join activities,” and “My close friend understands my feelings” [25]. Respondents rated how of-ten they receive the support/help described. The frequency ratings consist of a 6-point Likert scale from 1 (Never) to 6 (Always). Scores range from 48 - 288

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with higher scores indicative of higher social support. The CASSS has good in-ternal reliability which ranges from 0.89 - 0.97 for the total and subscale items and has been shown to be a valid measure of perceived social support for use with children and adolescents [25] [40].

2.5. Religiosity Measure

Religiosity was defined and measured as the frequency of involvement in reli-gious activities, private prayer, religious belief, and experience and it was meas-ured using the Duke University Religion Index (DUREL) [30]. The DUREL is a 5-item self-administered rating scale that measures the organizational, non-or- ganizational, and intrinsic dimensions of religiosity. An example of the question that measures non-organizational religiosity is “How often do you spend time in private religious activities such as prayer, meditation, and Bible study?” (1 = never or rarely, 2 = a few times a year, 3 = a few times a month, 4 = once a week, 5 = more than once a week, 6 = more than once a day). Scores range from 5 - 27. High scores indicate greater religiosity. The DUREL has overall high test-retest reliability, high internal consistence (Cronbach’s alpha’s = 0.70 - 0.91) and high convergent validity with other measures of religiosity [30] [41].

2.6. Spirituality Measure

Spirituality was measured using the Spiritual Well-Being Scale (SWBS) that contained self-belief statements about purpose and meaning in life, inner re-sources, unifying interconnectedness, and transcendence [34]. The SWBS is a 20 item rating scale that measures religious well-being (RWB) assessed by state-ment such as “I believe that God is concerned about my problems” and existen-tial well-being (EWB) with statement such as “I believe there is some real pur-pose for my life.” Items are rated and scored from 1 point to 6 points yielding a maximum possible score of 120, and a minimum possible score of 20. The SWBS has high internal reliability (Cronbach’s alpha = 0.78 - 0.94), high test-retest re-liability, correlates well with other measures of spirituality and valid for use with adolescents [34] [42].

2.7. Design and Statistical Analyses

The research design was cross-sectional, descriptive, and correlational. Descrip-tive statistics were used to summarize demographic characteristics of the sample. Spearman’s rho correlation was used to determine the bivariate relationship be-tween depression and social support, religiosity, and spirituality, whereas, mul-tiple regression model was used to analyze the relationships between depression and social support, religiosity, and spirituality. Gender differences in depression, social support, religiosity and spirituality were analyzed using the Mann-Whit- ney U-test, while Kruskal-Wallis One-Way Analysis of Variance (ANOVA) by Ranks was used to analyze age and ethnic differences. All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) Version 22.0.

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3. Results 3.1. Demographics

The data collected were screened for missing responses and entered into the SPSS Version 22.0. A total of 394 students participated in the study and 57.4% were females while 42.6% were males. There were 29.4%, 22.1%, 23.1% and 25.4% of 17, 16, 15, and 14 year olds respectively that participated in the study. The majority of the participants were Caucasian 47.0%. Other ethnic groups in-clude: Hispanic American (19.0%), Asian American (17.3%), African Ameri-can/Black (12.7%), and other (4.1%). Results are shown in Table 1.

The median scores for depression and religiosity were lower for males com-pared to females, but spirituality median value was higher for males compared to females. The median for depression was higher for 14 year olds compared to the other age groups. There were higher median values for social support for ado-lescents ages 15 and 17, but spirituality scores were lower for the 17 year old adolescents. Median scores for depression and spirituality were higher for Afri-can American adolescents. Asian and African American adolescent participants had lower median value for social support compared to the other ethnic groups (Table 1 and Figures 1-3).

3.2. Bivariate Relationship between Adolescent Depression and Social Support, Religiosity, and Spirituality

One of the objectives of the study was to determine if a relationship exists be-tween adolescent depression and social support, religiosity and spirituality in a faith-based high school. Spearman’s correlation was used for the analyses and results of the correlational analyses are displayed in Table 2.

Table 1. Participant demographic characteristics.

Demographic Characteristics

n (%) Depression Social

Support Religiosity Spirituality

Median (IQR) Median (IQR) Median (IQR) Median (IQR)

Gender Male

Female

168 (42.6) 226 (57.4)

12.00 (11.0) 13.00 (11.0)

202.0 (49.0) 202.0 (35.0)

18.50 (6.0) 19.00 (5.0)

96.00 (20.0) 93.00 (21.0)

Age 14 15 16 17

100 (25.4) 91 (23.1) 87 (22.1) 116 (29.4)

14.50 (14.0) 13.0 (11.0) 12.0 (8.0) 12.0 (13.0)

201.00 (42.0) 205.00 (50.0) 200.00 (52.0) 204.50 (37.0)

18.50 (7.0) 19.00 (6.0) 19.00 (8.0) 18.00 (5.0)

95.50 (22.0) 95.00 (17.0) 96.00 (21.0) 93.00 (19.0)

Ethnicity African American Asian American

Caucasian Hispanic American

Other

50 (12.7) 68 (17.3) 185 (47.0) 75 (19.0) 16 (4.1)

17.00 (11.0) 13.50 (11.0) 12.00 (13.0) 15.00 (10.0) 18.50 (27.0)

195.00 (106.0) 187.50 (58.0) 210.00 (37.0) 201.00 (35.0) 205.00 (0.21)

18.00 (6.0) 19.00 (6.0) 18.00 (7.0) 19.00 (7.0) 19.00 (8.0)

97.00 (22.0) 94.00 (18.0) 96.00 (19.0) 89.00 (27.0) 92.00 (30.0)

IQR = Interquartile range.

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Table 2. Bivariate correlations between social support, religiosity, spirituality and adoles-cent depression in a faith-based high school (N = 394).

Correlations

Depressive symptoms

Social support Religiosity Spirituality

r −0.127** −0.201** −0.492**

p (1-tailed) 0.006 0.00 0.00

N 394 394 394

**Correlation is significant at the 0.01 level (1-tailed).

Figure 1. Median scores for depression, social support, religiosity and spirituality for males and females. Religiosity scores were higher among females and there are also less variability in social support among the females, although outliers exist for both males and females in all measured indicators.

Results of the analyses presented in Table 2 show a significant negative bivariate correlation between social support and depression (r = −0.127, p < 0.05), reli-giosity and depression (r = −0.201, p < 0.05), and spirituality and depression (r = −0.492, p < 0.05) among adolescents who attend a faith-based high school. Spi-rituality was moderately correlated with adolescent depression compared to so-cial support and religiosity.

3.3. Multivariate Relationships between Adolescent Depression and Social Support, Religiosity, and Spirituality

The primary objective of the present study was to examine whether adolescent depression was related to combinations of social support, religiosity, and spiri-tuality in a faith-based high school and, if so, the amount of variance in depression

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Figure 2. Median scores for depression, social support, religiosity and spirituality for the different age groups. Most 16 year olds have lower levels of depression compared to the other age groups. There were extreme scores in most of the measured indicators.

Figure 3. Median scores for depression, social support, religiosity and spirituality for the different ethnic groups. African American and Asian American adolescents have much lower levels of social support compared to the other ethnic groups.

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that can be accounted for by the relationships. Variables were entered into a multiple regression model using the block entry method. The results are dis-played in Table 3. In Step 1 of the regression analyses, demographic variables (age, gender, and ethnicity) known to correlate with depression were entered. Results of the analyses showed that age, gender, and ethnicity were not signifi-cant predictors of depression. Social support and religiosity were entered in step 2 to assess their contribution to depression (see Table 3). Only ethnicity (r = −0.110, p < 0.05) and religiosity (r = −0.184, p < 0.00) were significant contribu-tors to the model and they accounted for 5.3% of the variance in depression (p < 0.00). Social support did not significantly contribute to the model (r = −0.066). The partial correlation output showed an r = −0.01, p = 0.441 for social support while controlling for the confounding effects of religiosity and spirituality (table not shown). Social support and spirituality were added in Step 3 of the regres-sion model and spirituality was the only variable that significantly contributed to the model (r = −0.477) explaining an additional 23.9% of the variance in depres-sion (p = 0.00). A partial correlation output indicated an r = −0.465, p = 0.00 for spirituality, while controlling for the influence of social support and religiosity.

In Step 4, religiosity and spirituality measures were added to determine the amount of variance in depression that can be accounted for by the variables. Re-sults showed that religiosity (r = 0.121, p < 0.05) and spirituality (r = −0.548, p = 0.00) were both significant contributors to the model and they explained 24.9% of the variance. Higher religiosity did not correlate with lower depression; ra-ther, it was related to higher depression when entered with spirituality. The par-tial correlation output confirmed the significant positive relationship between religiosity and depression r = 0.125, p = 0.01, while controlling for the con-founding effects of social support and spirituality. In the final model, social support, religiosity and spirituality measures were entered in Step 5 to determine the amount of variance in depression that can be accounted for by the three va-riables. The final model was significant (p < 0.01), although the amount of va-riance did not change from what was obtained in Step 4. Social support still did not make any significant contribution to the variance in depression. The only two significant predictors in the final model were religiosity (r = 0.121, p < 0.05) and spirituality (r = −0.548, p = 0.00), indicating that spirituality may be a more important predictor of good mental health than religiosity and social support for adolescents (Table 3).

3.4. Gender, Age, and Ethnic Differences in Depression, Social Support, Religiosity, and Spirituality among Adolescents in a Faith-Based High School

Gender differences in depression, social support, religiosity, spirituality scores were analyzed using Mann Whitney U test. Results of the Mann Whitney U test showed statistically significant gender differences in religiosity (p = 0.04). Mean rank for males was 184, while the mean rank for females was 207. However, there were no statistically significant gender differences in perceived social sup-port, spirituality and depression among the adolescents in the faith-based high

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school (Table 4). Age differences in social support, religiosity, spirituality, and depression were

analyzed using Kruskal-Wallis one way analysis of variance by ranks. Results of the H test indicated no statistically significant differences in perceived social support, religiosity, spirituality and depression (p > 0.05) among the different age groups (Table not shown). Further analyses using the Kruskal-Wallis one way analysis of variance by ranks showed statistical significant ethnic differences only in perceived social support (see Table 5).

In order to determine if specific ethnic groups were different from each other in social support, Mann Whitney U-test was used for pairwise comparisons. To control for increased risk of Type 1 error, a Bonferroni correction was applied. Ten pairwise comparisons were conducted (see Table 6).

Only the comparisons between African American and Caucasian students

Table 3. Multiple linear regression models correlating combinations of supportive meas-ures (social support, religiosity, spirituality), and adolescent depression in a faith-based high school (n = 394).

Variables Depressive Symptoms

Step 1 Step 2 Step 3 Step 4 Step 5

Age −0.047 −0.049 −0.041 −0.038 −0.038

Gender 0.058 0.080 0.076 0.066 0.066

Ethnicity 0.090 0.110* 0.040 0.026 0.029

Social Support −0.066 −0.012 −0.014

Religiosity −0.184** 0.121* 0.121*

Spirituality −0.477** −0.548** −0.546**

R 0.113 0.230 0.489 0.499 0.499

R2 0.013 0.053** 0.239** 0.249** 0.249**

Standardized β weights are reported at each step to evaluate any changes in weights with the inclusion of additional predictors. *p < 0.05 (2 tail). **p < 0.01 (2 tail).

Table 4. Differences in social support, religiosity, spirituality and depression between male and female adolescents (n = 394).

Gender n Mean Rank

p

Social Support

M F

168 226

194 200

0.59

Religiosity M F

168 226

184 207

0.04*

Spirituality M F

168 226

195 199

0.68

Depression M F

168 226

191 202

0.33

*p < 0.05 (two tailed test).

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Table 5. Differences in social support, religiosity, spirituality and depression among the ethnic groups (n = 394).

Ethnic group N Mean Rank

p

Social African A. Support Asian A.

Caucasian Hispanic

Other

50 68 185 75 16

149.93 155.60 225.83 195.31 206.97

0.00*

Religiosity African A. Asian A.

Caucasian Hispanic

Other

50 68 185 75 16

173.79 219.49 190.39 207.45 213.78

0.17

Spirituality African A. Asian A.

Caucasian Hispanic

Other

50 68 185 75 16

211.26 201.17 204.99 173.56 164.47

0.19

Depression African A. Asian A.

Caucasian Hispanic

Other

50 68 185 75 16

218.54 192.68 184.93 209.80 239.94

0.14

*p < 0.05 (two tailed test).

(mean difference = −34.80, p = 0.00) and Asian American and Caucasian stu-dents (mean difference = −25.07, p = 0.00) were significant, revealing that Cau-casian students perceived significantly higher social support than both African American and Asian American students.

4. Discussion 4.1. Major Findings of the Study

The primary objective of this study was to examine how adolescent depression relates to combinations of social support, religiosity, and spirituality in a faith- based high school. This study was based on the notion that having broad sup-portive relationships promote an individual’s sense of purpose, belonging, secu-rity, self-esteem, and overall well-being [29]. Consistent with previous studies [21] [23] [24], the present study found weak to moderate, but significant biva-riate correlations between depression and social support, religiosity, and spiri-tuality; an indication that social support, frequent participation in religious ac-tivities, and spiritual interconnectedness are good for mental and emotional well-being of adolescents. Yet, in some other studies, some aspects of religiosity such as private religious practices were not associated with depression in adoles-cents [26] [31] [33].

In the multiple regression analyses, social support did not significantly con-tribute to the model when entered with religiosity and spirituality. This finding

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Table 6. Mann whitney u-test for multiple comparisons using bonferroni correction (n = 394).

(I) Ethnic group (J) Ethnic group Mean Difference (I-J) Std. Error Sig.

African American

Asian American −9.73 7.66 1.000

Caucasian −34.80* 6.56 0.00

Hispanic American −25.83 7.51 0.00

Other −28.79 11.81 0.15

Asian American

African American 9.73 7.66 1.00

Caucasian −25.07* 5.83 0.00

Hispanic American −16.09 6.89 0.19

Other −19.06 11.43 0.96

Caucasian

African American 34.80* 6.56 0.00

Asian American 25.07* 5.83 0.00

Hispanic American 8.97 5.63 1.00

Other 6.01 10.72 1.00

Hispanic American

African American 25.83 7.51 0.00

Asian American 16.09 6.89 0.19

Caucasian −8.97 5.63 1.00

Other −2.97 11.33 1.00

Other

African American 28.79 11.81 0.15

Asian American 19.06 11.43 0.96

Caucasian −6.01 10.72 1.00

Hispanic American 2.97 11.33 1.00

*The mean difference is significant at the 0.005 level (two tailed test).

suggests that the emotional, informational, appraisal and tangible support re-ceived from family, teachers, classmates, and close friends may not adequately protect adolescents from poor psychological outcome such as depression. In steps 4 and 5 of the model, the combination of religiosity and spirituality was found to be important predictors of depression among adolescents, but each re-lated to depression in the opposite direction. Spirituality was negatively related to adolescent depression, while religiosity was positively related to it. Together, both variables explained 24.9% of the variance in depression. It was surprising to find that higher religiosity predicted higher levels of adolescent depression. Al-though this finding was unexpected, similar results were obtained in a different study that investigated the impact of adolescent spirituality on depressive symp-toms and health risk behaviors [24]. The study found that religiosity had a posi-tive relationship with depression when combined with spirituality. Religiosity explained just 1% of the variance, whereas when combined with spirituality they explained 36% of the variance in adolescent depression [24]. It is possible that social support and the different aspects of religion does not help adolescents

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adequately address the questions of meaning, purpose, and sense of direction which they try to figure out during this period of emotional turmoil which cha-racterizes adolescence. Consistent with the findings of this study, a different study carried out with terminally ill patients found that religiosity was positively associated with depression when entered with spirituality in a multivariate ana-lyses [43]. According to the authors, individuals with strong religious beliefs may not want to accept or express the anger they feel towards their God in their stressful life situations, so the resulting conflict adds to the psychological and physiological problems they are already experiencing. Given the challenges of maturing physically, cognitively, and psychologically, religious activities and be-lief may not provide adolescents with the resources they need to discover who they are, what they are about, and where they are heading to in life [44], but may add to the crises.

On the other hand, spirituality turned out to be the most important significant predictor of depression (β = −0.548, p < 0.01). The moderate negative correla-tion found between spirituality and depression could be due to life satisfaction, peace, hope, and comfort derived from the interconnectedness with the higher power, other people, places, and things. Spirituality may counter stress and pre-vent depression by weakening its impact and providing individuals with person-al meaning and social and inner resources they can call on in stressful situations [45] [46]. The process of making and finding meaning in life may be one me-chanism that links spirituality to less depression since finding meaning in life leads to hope, and the feeling of being valued in relationships promotes one’s dignity [45] [47] [48]. While not everyone is religious, everyone who searches for ultimate or transcendent meaning has spirituality. This search for meaning can be expressed in religious practices, in one’s relationship with a higher being, nature, music, art, philosophical beliefs, or relationship with family and friends [47]. The consistent negative correlation between spirituality and depression was also supported in a different study of primary care outpatients [49]. Finally, the present study showed that the role of social support and religiosity in reducing depression among adolescents may not be as important as spirituality since the development of meaning and purpose in one’s life helps to promote resiliency and a sense of direction and purpose.

4.2. Other Findings of the Study

The present study did not find statistically significant gender differences in de-pression, social support, and spirituality among the adolescent participants con-sistent with previous works [50] [51]. The lack of significant gender differences in depression found in the present study contrasts previous works which re-ported that adolescent females had significantly higher depression scores than males [5] [6] [7] [52] [53]. However, these studies were either conducted using community samples or in public school settings. Conversely, the present study was carried out in a faith-based setting. It is possible that adolescent males and females in this large faith-based high school are exposed to the environment that

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promotes a sense of belonging and connectedness and activities that help them cope with daily life stressors thus buffering them from depression.

Furthermore, the study only found significant gender differences in religiosi-ty. Females in this study had greater levels of engagement in religious activities than males. Significant gender differences in religiosity were also reported in other studies [31] [36], whereas a different study did not find statistically signif-icant gender differences in religiosity [32]. In addition, there were no age differ-ences in depression, social support, religiosity, and spirituality. The lack of age differences found in this study was supported in a previous study [5], whereas other studies found that depressive symptoms increase with age [20] [28]. This lack of age differences in all four measures found in the present study suggests that adolescent males and females at different grade levels may be similar in their perception of social support, religious beliefs and engagement, and spiritual, emotional and mental well-being.

Significant ethnic differences were not found in religiosity, spirituality and depression, but ethnic differences were found in social support. Caucasian stu-dents perceived significantly higher social support than African American and Asian American students consistent with a previous work [25]. The significantly low social support reported by Asian American students in this study may be due to the fact that most of them did not live with their parents, but a guardian (School demographic data, 2011) so they may not be experiencing the parental love, care, and support they need. The African American participants in the study reported low social support which may be attributed to the fact that most of them in the school come from a single parent/guardian homes (School demo-graphic data, 2011).

5. Conclusions

This research is the first of its kind to be conducted in a faith-based high school. It is also the first to explore how adolescent depression relates to social support, religiosity, and spirituality in multivariate analyses. The finding of the study supports the notion that being in a broad range of supportive relationships pro-tects an individual from the negative health outcome; depression. The findings that religiosity and spirituality relate to depression in opposite direction may suggest to researchers in this area to go beyond exploring just the bidirectional relationship between adolescent depression and social support, religiosity, and spirituality to exploring multivariate relationships between adolescent depres-sion and the different protective measures. Combining social support, religiosity, and spirituality not only revealed how much each predicted depression, but also the direction of the relationship. One striking contribution of this study is the importance of spirituality over religiosity and social support in buffering depres-sion in adolescents. It is likely that spiritual individuals are able to draw their strength from within themselves and thus feel in control of both themselves and situations in which they find themselves. With the rise in suicides and mental

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health issues among adolescents in the United States, the results of this study suggest the need to develop programs that encourage youths to address ques-tions of meaning, value, and relationships in their lives. This study has particular relevance to faith-based schools as it suggests the need for faith-based school administrators and educators to explore and implement activities and programs that can engage students in various spiritual practices. If spirituality is related to lower depression in adolescents, then educators should encourage students to engage in activities that can help them find meaning and sense of purpose in life.

The study has some limitations. First, a convenience sample of 394 students from a population of 1569 in the faith-based high school who participated in the study is a little low; therefore the findings may only be generalized to similar set-tings and population. Second, depressive symptoms measure was detected by self-administered scale measure. It is better to test the depressive symptoms by professionals. Third, the use of cross-sectional design makes it difficult to de-termine causal relationships between the variables, but it provides a baseline in considering the relationship between adolescent depression and combinations of protective measures in other faith-based schools and community setting. Finally, psychosocial variables such as family structure, physical exercise etc. known to relate to depression in adolescents were not assessed. Including these variables in the study would have broadened our understanding of the factors that relate to depression in adolescents. Despite the limitations inherent in the study, the re-search findings could be used as a point of reference for future studies that will explore the multivariate relationships between adolescent depression and social support, religiosity, and spirituality. Therefore, future researchers should repli-cate the present study in different faith-based high schools or even at the college level to see if their findings will add evidence to the results of the present study. If possible, the methodology could be modified by collecting data longitudinally as this could provide a clearer understanding of the relationships between the variables. Furthermore, instead of using summed Likert score, researchers could investigate how the different dimensions of social support (parents, teachers, classmates, and close friends) religiosity (organizational, non-organizational, and intrinsic) and spirituality (existential and religious well-being) relate to depres-sion. Assessing the relationship between depression and the various dimensions of the measures may produce a different outcome. Finally, the continuing efforts to expand the knowledge about adolescent depression and social support, reli-giosity, and spirituality are obviously supported by this study.

Acknowledgements

The authors wish to thank Joan O’Grady who helped out during the data collec-tion process and Joseph Agostino, the School Principal who permitted the study to be conducted in the school.

Competing Interests

The authors declare no competing interests.

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Authors’ Contributions

Angela U. Ekwonye: design, data collection, statistical analyses and manuscript review. Terrence Cahill: design, statistical analyses and manuscript review. De-borah DeLuca & Lee Cabell: design and statistical analyses.

References [1] Birmaher, B., Ryan, N.D., Williamson, D.E., Brent, D.A., Kaufman, J., Dahl, R.E.,

Nelson, B., et al. (1996) Childhood and Adolescent Depression: A Review of the Past 10 Years. Part I. Journal of the American Academy of Child & Adolescent Psy-chiatry, 35, 1427-1439. https://doi.org/10.1097/00004583-199611000-00011

[2] Gonzá-Tejera, G., Canino, G., Ramírez, R., Chávez, L., Shrout, P., Bird, H., Bauer-meister, J., et al. (2005) Examining Minor and Major Depression in Adolescents. Journal of Child Psychology & Psychiatry, 46, 888-899. https://doi.org/10.1111/j.1469-7610.2005.00370.x

[3] Holler, K., Kavanaugh, B. and Cook, N.E. (2014) Executive Functioning in Adoles-cent Depressive Disorders. Journal of Child and Family Studies, 23, 1315-1324. https://doi.org/10.1007/s10826-013-9789-z

[4] Crowe, M., Ward, N., Dunnachie, B. and Roberts, M. (2006) Characteristics of Adolescent Depression. International Journal of Mental Health Nursing, 15, 10-18. https://doi.org/10.1111/j.1447-0349.2006.00399.x

[5] Lewinsohn, P.M., Hops, H., Roberts, R.E., Seeley, J.R. and Andrews, J.A. (1993) Adolescent Psychopathology: I. Prevalence and Incidence of Depression and Other DSM-III-R Disorders in High School Students. Journal of Abnormal Psychology, 102, 133-144. https://doi.org/10.1037/0021-843X.102.1.133

[6] Field, T., Diego, M. and Sanders, C. (2001) Adolescent Depression and Risk Factors. Adolescence, 36, 491-498.

[7] Boyd, C.P., Kostanski, M., Gullone, E., Ollendick, T.H. and Shek, D.T. (2000) Pre-valence of Anxiety and Depression in Australian Adolescents: Comparisons with Worldwide Data. The Journal of Genetic Psychology, 161, 479-492. https://doi.org/10.1080/00221320009596726

[8] Bansal, V., Goyal, S. and Srivastava, K. (2009) Study of Prevalence of Depression in Adolescent Students of a Public School. Industrial Psychiatry Journal, 18, 43-46. https://doi.org/10.4103/0972-6748.57859

[9] Center for Behavioral Health Statistics and Quality (2015) Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). http://www.samhsa.gov/data/

[10] Frőjd, S.A., Nissinen, E.S., Pelkonen, U.I., Marttunen, M.J., Koivisto, A. and Kaltia-la-Heino, R. (2008) Depression and School Performance in Middle Adolescent Boys and Girls. Journal of Adolescence, 31, 485-498. https://doi.org/10.1016/j.adolescence.2007.08.006

[11] Fortin, L., Marcotte, D., Potvin, P., Royer, E. and Joly, J. (2006) Typology of Stu-dents at Risk of Dropping Out of School: Description by Personal, Family and School Factors. European Journal of Psychology of Education, 21, 363-383. https://doi.org/10.1007/BF03173508

[12] O’Connor, T.G., McGuire, S., Reiss, D., Hetherington, E.M. and Plomin, R. (1998) Co-Occurrence of Depressive Symptoms and Antisocial Behavior in Adolescence: A Common Genetic Liability. Journal of Abnormal Psychology, 107, 27-37. https://doi.org/10.1037/0021-843X.107.1.27

A. U. Ekwonye et al.

54

[13] Meadows, S.O. (2007) Evidence of Parallel Pathways: Gender Similarity in the Im-pact of Social Support on Adolescent Depression and Delinquency. Social Forces, 85, 1143-1167. https://doi.org/10.1353/sof.2007.0048

[14] Anderson, D.M., Cesur, R. and Tekin, E. (2015) Youth Depression and Future Criminal Behavior. Economic Inquiry, 53, 294-317. https://doi.org/10.1111/ecin.12145

[15] Testa, C.R. and Steinberg, L. (2010) Depressive Symptoms and Health-Related Risk-Taking in Adolescence. Suicide & Life-Threatening Behavior, 40, 298-305.

[16] Brooks, T.L., Harris, S.K., Thrall, J.S. and Woods, E.R. (2002) Association of Ado- lescent Risk Behaviors with Mental Health Symptoms in High School Students. Journal of Adolescent Health, 31, 240-246. https://doi.org/10.1016/S1054-139X(02)00385-3

[17] Polednak, A.P. (2014) Persistent Disparity in Prevalence of Current Cigarette Smoking between US Adolescents with vs. without a Past-Year Major Depressive Episode. Community Mental Health Journal, 50, 179-184. https://doi.org/10.1007/s10597-013-9676-5

[18] Balázs, J., et al. (2013) Adolescent Subthreshold-Depression and Anxiety: Psycho-pathology, Functional Impairment and Increased Suicide Risk. Journal of Child Psychology and Psychiatry, 54, 670-677. https://doi.org/10.1111/jcpp.12016

[19] Repetto, P.B., Caldwell, C.H. and Zimmerman, M.A. (2004) Trajectories of De-presssion among High Risk African-American Adolescents. Journal of Adolescent Health, 35, 468-477. https://doi.org/10.1016/S1054-139X(04)00095-3

[20] Fitzpatrick K.M., Piko, B.F., Wright, D.R. and LaGory, M. (2005) Depressive Symp tomatology, Exposure to Violence, and the Role of Social Capital among African American Adolescents. American Journal of Orthopsychiatry, 75, 262-274. https://doi.org/10.1037/0002-9432.75.2.262

[21] Hall-Lande, J.A., Eisenberg, M.E., Christenson, S.L. and Neumark-Sztainer, D. (2007) Social Isolation, Psychological Health, Protective Factors in Adolescence. Adolescence, 42, 265-286.

[22] Cohen, S. and Wills, T.A. (1985) Stress, Social Support, and the Buffering Hypothe-sis. Psychological Bulletin, 98, 310-357. https://doi.org/10.1037/0033-2909.98.2.310

[23] Sinha, J.W., Cnaan, R.A. and Gelles, R.J. (2007) Adolescent Risk Behaviors and Re-ligion: Findings from a National Study. Journal of Adolescence, 30, 231-249. https://doi.org/10.1016/j.adolescence.2006.02.005

[24] Cotton, S., Larkin, E., Hoopes, A., Cromer, B.A. and Rosenthal, S.L. (2005) The Impact of Adolescent Spirituality on Depressive Symptoms and Health Risk Beha-viors. Journal of Adolescent Health, 36, 529. https://doi.org/10.1016/j.jadohealth.2004.07.017

[25] Malecki, C.K. and Demaray, M.K. (2002) Measuring Perceived Social Support: De-velopment of the Child and Adolescent Social Support Scale (CASSS). Psychology in the School, 39, 1-18. https://doi.org/10.1002/pits.10004

[26] Houltberg, B., Henry, C., Merten, M. and Robinson, L. (2011) Adolescents’ Percep-tions of Family Connectedness, Intrinsic Religiosity, and Depressed Mood. Journal of Child & Family Studies, 20, 111-119. https://doi.org/10.1007/s10826-010-9384-5

[27] Nasser, E.H. and Overholser, J.C. (2005) Recovery from Major Depression: The Role of Support from Family, Friends, and Spiritual Beliefs. Acta Psychiatrica Scan-dinavica, 111, 125-132. https://doi.org/10.1111/j.1600-0447.2004.00423.x

[28] Schraedley, P.K., Gotlib, I.H. and Hayward, C. (1999) Gender Differences in Corre-

A. U. Ekwonye et al.

55

lates of Depression in Adolescents. Journal of Adolescent Health, 25, 98-108. https://doi.org/10.1016/S1054-139X(99)00038-5

[29] Cohen, S., Gottlieb, B.H. and Underwood, L.G. (2001) Social Relationships and Health: Challenges for Measurement and Intervention. Advances in Mind-Body Medicine, 17, 129-141.

[30] Koenig, H.G., Pakerson, G.R. and Meador, K.G. (1997) Religion Index for Psychia-tric Research: A Five-Item Measure for Use in Health Outcome Studies. American Journal of Psychiatry, 154, 885-886.

[31] Pearce, M.J., Little, T.D. and Perez, J.E. (2003) Religiousness and Depressive Symp-toms among Adolescents. Journal of Clinical Child and Adolescent Psychology, 32, 267-276. https://doi.org/10.1207/S15374424JCCP3202_12

[32] Schapman, A.M. and Inderbitzen-Nolan, H.M. (2002) The Role of Religious Beha-vior in Adolescent Depressive and Anxious Symptomatology. Journal of Adoles-cence, 25, 631-643. https://doi.org/10.1006/jado.2002.0510

[33] Wenger, S. (2011) Religiosity in Relation to Depression and Well-Being among Adolescents—A Comparison of Findings among the Anglo-Saxon Population and Findings among Austrian High School Students. Mental Health, Religion & Culture, 14, 515-529. https://doi.org/10.1080/13674676.2010.487481

[34] Paloutzian, R.F. and Ellison, C. (1982) Spiritual Well-Being Scale. Measures of reli-giosity, 382-385.

[35] Tripathi, M. and Asthana, H.S. (2013) Spirituality and Religiosity as Coping Strate-gies in Terminal Illness. Indian Journal of Health and Wellbeing, 4, 1180-1184.

[36] Desrosiers, A. and Miller, L. (2007) Relational Spirituality and Depression in Ado-lescent Girls. Journal of Clinical Psychology, 63, 1021-1037. https://doi.org/10.1002/jclp.20409

[37] Yi, M.S., Mrus, J.M., Wade, T.J., Ho. M.L., Hornung, R.W., Cotton, S., et al. (2006) Religion, Spirituality, and Depression in Patients with HIV/AIDS. Journal of Gen-eral Internal Medicine, 21, S21-S27. https://doi.org/10.1111/j.1525-1497.2006.00643.x

[38] Weissman, M.M., Orvaschel, H. and Padian, N. (1980) Children’s Symptom and Social Functioning Self-Report Scales: Comparison of Mothers’ and Children’s Re-ports. Journal of Nervous Mental Disorders, 168, 736-740. https://doi.org/10.1097/00005053-198012000-00005

[39] Fendrich, M., Weissman, M.M. and Warner, V. (1990) Screening for Depressive Disorder in Children and Adolescents: Validating the Center for Epidemiologic Studies Depression Scale for Children. American Journal of Epidemiology, 131, 538-551.

[40] Malecki, C.K., Demaray, M.K. and Elliott, S.N. (2000) The Child and Adolescent Social Support Scale. Northern Illinois University, DeKalb.

[41] Koenig, H.G. and Büssing, A. (2010) The Duke University Religion Index (DUREL): A Five-Item Measure for Use in Epidemological Studies. Religions, 1, 78-85. https://doi.org/10.3390/rel1010078

[42] Gomez, R. and Fisher, J.W. (2003) Domains of Spiritual Well-Being and Develop-ment and Validation of the Spiritual Well-Being Questionnaire. Personality and In-dividual Differences, 35, 1975-1991. https://doi.org/10.1016/S0191-8869(03)00045-X

[43] Nelson, C.J., Rosenfeld, B., Breitbart, W. and Galietta, M. (2002) Spirituality, Reli-gion, and Depression in the Terminally Ill. Psychosomatics, 43, 213-220. https://doi.org/10.1176/appi.psy.43.3.213

A. U. Ekwonye et al.

56

[44] Erickson, E.H. (1968) Identity: Youth and Crisis. Norton, New York.

[45] Ellison, C.G. and Levin, J.S. (1998) The Religion-Health Connection: Evidence, Theory, and Future Directions. Health Education & Behavior, 25, 700-720. https://doi.org/10.1177/109019819802500603

[46] Pargament, K.I. (1997) The Psychology of Religion and Coping: Theory, Research, Practice. Guilford Press, New York.

[47] Sulmasy, D.P. (2002) A Biopsychosocial-Spiritual Model for the Care of Patients at the End of Life. The Gerontologist, 42, 24-33. https://doi.org/10.1093/geront/42.suppl_3.24

[48] Park, C.L. and Folkman, S. (1997) Meaning in the Context of Stress and Coping. Review of General Psychology, 1, 115-144. https://doi.org/10.1037/1089-2680.1.2.115

[49] Daaleman, T.P. and Kaufman, J.S. (2006) Spirituality and Depression in Primary Care Outpatients. Southern Medical Journal, 99, 1340-1344. https://doi.org/10.1097/01.smj.0000223948.59194.e9

[50] Galambos, N.L., Leadbeater, B.J. and Barker, E.T. (2004) Gender Differences in and Risk Factors for Depression in Adolescence: A 4-Year Longitudinal Study. Interna-tional Journal of Behavioral Development, 28, 16-25. https://doi.org/10.1080/01650250344000235

[51] Davis, T.L., Kerr, B.A. and Kurpius, S.E.R. (2003) Meaning, Purpose, and Religiosity in At-Risk Youth: The Relationship between Anxiety and Spirituality. Journal of Psychology & Theology, 31, 356-365.

[52] Lewinsohn, P.M., Roberts, R.E., Seeley, J.R., Rohde, P., Gotlib, I.H. and Hops, H. (1994) Adolescent Psychopathology: II. Psychosocial Risk Factors for Depression. Journal of Abnormal Psychology, 103, 302-315. https://doi.org/10.1037/0021-843X.103.2.302

[53] Lyons, A.L., Carlson, G.A., Thurm, A.E., Grant, K.E. and Gipson, P.Y. (2006) Gender Differences in Early Risk Factors for Adolescent Depression among Low- Income Urban Children. Cultural Diversity & Ethnic Minority Psychology, 12, 644- 657. https://doi.org/10.1037/1099-9809.12.4.644

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